All posts by Dr Deepan

Dr DEEPAN P SHAH MD(HOMOEOPATHY) SPECIALISED HOMEOPATHIC PHYSICIAN AND SURGEON

AUTOIMMUNE HEMOLYTIC ANAEMIA

Autoimmune Hemolytic Anaemia (AIHA) also called Immunohemolytic Anaemia is an autoimmune condition where in there are antibodies driven against our own Red Blood Cells. Due to which there is excessive destruction of RBC reducing oxygen carrying capacity of blood.

Pathophysiology

Causes of AIHA

Autoimmune Hemolytic Anaemia (AIHA) is believed to be caused due to genetic predisposition and environmental insults on the genome. Still no specific HLA locus has been found which can be related with AIHA in other words, no Human Leucocyte Antigen association has been established yet.

It can be also be secondary to other Autoimmune diseases, Cancers and Infections as mentioned below

1) Autoimmune diseases like

  • Systemic Lupus Erythematosus (SLE)
  • Rheumatoid Arthritis(RA)
  • Crohn’s Disease
  • Ulcerative Colitis
  • Scleroderma
  • Autoimmune Hepatitis
  • etc

2) Cancers like

  • Chronic Lymphocytic Leukemia
  • Non-Hodgkin’s Lymphoma
  • Other Blood Cancers

3) Infections like

  • Mycoplasma infections
  • Cytomegalovirus(CMV)
  • Epstein-Barr Virus
  • Human Immunodeficiency Virus (HIV)
  • Infectious Mononeucleosis
  • Viral Pneumonitis
  • Viral Hepatitis

Differentiation of AIHA

Based on optimal temperature required for reaction of autoantibody of IgG class and autologous erythrocytes AIHA can be differentiated into

  • Warm Autoimmune Hemolytic Anaemia (wAIHA)
  • Cold Autoimmune Hemolytic Anaemia, further classified into i)Cold Aglutinin Disease (CAD) and ii) Paroxysmal Cold Heamoglobinuria(PCT). These both subtypes can be acute or chronic.
  • Mixed Type
  • Atypical (DAT- negative, IgM -wAIHA)
  • Drug Induced

Classification of AIHA

Clinically AIHA can be clasified as Primary or Secondary

Primary AIHA – It is also called Idiopathic AIHA has no known underlying causative factor and presents itself with hemolysis as predominant feature and other complaints are secondary to it. This type can either be cold or warm thermal relation to reaction mention in above differentiation.

Secondary AIHA – It is usually associated with some primary underlying disease condition. This type usually shows cold thermal relation in reaction that is Cold Agglutinin Disease Category.

Pathogenesis

Autoimmune Hemolytic Anaemia characterises itself by presence of Anti-RBC autoantibodies with or without activation of Complement-Cascade causing excessive destruction of Erythrocytes(RBC).

There are many mechanisms involved in pathogenesis of AIHA. It is a complex scenario with many mechanisms involing Autoantibodies, Phagocytosis, Antibody Dependent Cell-Mediated Cytotoxity, B Lymphocutes and T Lymphocytes, T regs, Cytokines, and Complement System.

Antibody Dependent Cell-Mediated Cytotoxicity (ADCC)

Auto-antibodies are formed by both tissue and circulating self reactive B-Lymphocytes in co-ordination with T-Helper Lymphocytes.IgG sub-classes IgG1 IgG2 IgG3 and IgG4 are involved in ADCC.

Cytotoxic CD8+ T cells and NK cells opsonize the RBC’s with fc portion of IgG for attracting fc receptors on macrophages thus resulting in destruction of RBC by phagocytosis. Occurs in Spleen and lymphoid organs.

Note- Spleenectomy in most cases doesnt have much effect on the disease as in slpeen the erythrolysis is in very lesser proportion in most AIHA cases.

Activation of Final Components of Complement Cascade (Membrane Attack Complex)- DIRECT LYSIS.

IgM dependent- IgM mediated compliment activation results in direct osmotic lysis of RBC, through sequential activation of Membrane attack complex(MAC), in circulation. Also C3b opsonisation of red blood cells by compliment activation results into extracellular erythrolysis by kufper cells of liver, 10 folds more destruction of RBC if compared to ADCC. IgG1 and IgG3 are also responsible in compliment activation to some degree. Majority of erythrolysis is extravascular especially in liver by kufper cells.

SIGNS AND SYMPTOMS

Symptoms develop gradually over months with presenting symptoms usually proportionate to degree of anaemia

  • General signs of anaemia depending on degree of anaemia like weakness, lethargy, breathless, etc
  • signs of Red blood cell destruction.
  • Heamoglobinuria
  • Spherocytes in RBC morphology
  • Increased LDH
  • Spleenomegaly
  • Hepatomegaly
  • Reticulocytes in Circulation
  • Hepatoglulin
  • Jaundice which may be mild to moderate or even severe
  • Angina

DIAGNOSIS of AIHA

  • COOMB’s Test
  • DAT test
  • CBC
  • LDH

HOMEOPATHIC TREATMENT FOR AUTOIMMUNE HEMOLYTIC ANAEMIA (AIHA)

  • Ferrum Metallicum
  • Ferrum Phosphoricum
  • Calcarea Phosphoricum
  • Calcarea Flourica
  • Ruta
  • Calcarea Carbonica
  • Lycopodium
  • Cinchonna Officinalis
  • Arsenicum Album
  • Lachesis
  • Naja
  • Chelidonium Majus

ANAEMIA

Anaemia can be defined as decreased haemoglobin counts or reduced red blood cell counts or reduced oxygen carrying capacity of blood, due to “loss of” or “abnormality of” red blood cells or haemoglobin.

Normal Heamoglobin Counts

  • 6 months to 5 years of age > 11g/dl
  • 5 years to 12 years of age > 11.5g/dl
  • 12years to 16 years of age > 12g/dl
  • Adult Females (non-pregnant) > 12g/dl
  • Adult Females (pregnant) > 11gm/dl
  • Adult Males > 13g/dl

CAUSES OF ANAEMIA

  • Blood losss
  • Excessive Red Blood Cell destruction
  • Heamoglobinopathies
  • Hypovitaminosis B12
  • Hypoferremia
  • Anaemia of Chronic diseases
  • Autoimmune haemolytic anaemia
  • Inflamatory bowel diseases
  • Hypervolemia or water retention due to sodium or other salts.
  • Genetic hereditary conditions like Thalasemia
  • Certain cancers
  • Kidney diseases
  • Reduced erythropoetin production
  • Excessive RBC destruction
  • Impaired RBC production
  • Certain infections like malaria which causes RBC destruction.
  • Certain drugs which causes RBC destruction eg. Quinine causes chinchonism.
  • Bone Marrow lesions and pathologies
  • Etc.

CLASSIFICATION OF ANAEMIA

There are many types of anaemias. It can be broadly classified into 7 categories depending upon their causes

Anaemia due to

  1. Blood Loss
  2. Hemolysis
  3. Impaired or abnormal Erythropoesis
  4. Hypervolemia
  5. Chronic Diseases
  6. Nutritional deficiency

Based on RBC morphology it can be classified into 3 groups

  • Microcytic
  • Macrocytic
  • Normocytic

FEW COMMON and RARE TYPES OF ANAEMIA

  • Iron Deficiency Anaemia
  • Aplastic Anaemia
  • Megaloblastic Anaemia
  • Pernicious Anaemia
  • Sideroblastic Anaemia
  • Autoimmune Hemolytic Anaemia
  • Myelodysplastic Syndrome
  • Thalasemia
  • Fanconi Anaemia
  • Congenital Dyserythropoetic Anaemia
  • Daimond-Blacfan Anaemia
  • Myelopthisis
  • Anaemia of Prematurity
  • Erythroblastopenia or Pure Red Cell Aplasia
  • Hereditary Spherocytosis
  • Hereditary Elliptocytosis

SYMPTOMS

  • Weakness
  • Lethargy
  • In children it affects growth in general
  • Somnolence, Drowziness in day time
  • Disturbed sleep at night
  • Pallor, general pale appearance of skin, mucous membranes and eyes.
  • Dyspnoea on Exertion.
  • Reduced Immunity, tendency to catch infections and slow recovery and healing.
  • Bodyaches
  • Cyanosis in severe cases
  • Palpitations
  • Tachycardia
  • Low blood pressure
  • Chest pain
  • Depression
  • Craving for indigestible things , PICA
  • Cold clammy extremities
  • Oedematous swelling of extremities, dependent oedema
  • Angina or cardiac failure in severe cases
  • Will impact general growth and repair of all the vital organs and tissue of the body.

HOMEOPATHIC MEDICINES FOR ANAEMIA

Depending upon the cause of anaemia and general constitution of the patient, one of the following medicines may be called for duty by a homeopathic physician.

  • Ferrum Metallicum
  • Ferrum Phosphoricum
  • Cinchonna Officinalis
  • Natrum Muriatic um
  • Arsenicum Album
  • Abrotanum
  • Hamamelis Verginiana
  • Pulsatilla Nigricans
  • Janosia Ashoka
  • Crotalus Horridus
  • Lachesis
  • Acidum Phosphoricum

COVID-19 NOVEL CORONAVIRUS 2019 INFECTION

COVID-19 Coronavirus Disease 2019

COVID-19 term is derived from “CO”rona”VI”rus “D”isease 20″19” it is caused due to Novel Coronavirus also known as 2019-nCoV or SARS-CoV-2. It is commonly known as Wuhan Coronavirus or Wuhan Sea Food Market Pneumonia Virus is an enveloped positive sense, single strand, RNA Coronavirus with a neucleocapsid of helical symetry which can infect and spread through human to human transmission causing flu like illness officially termed by WHO as Covid-19 where “Co” represents CORONA, “vi”represents virus, “d” stands for disease and “19” stands for year of first outbreak 2019.

Novel Coronavirus 2019-nCoV or SARS-CoV-2 Classification

Novel Coronavirus belongs to

  • Realm -Riboviria
  • Phylum -Incertia Sedis
  • Order -Nidoviralis
  • Family -Coronaviridae
  • Genus -Beta Corona virus
  • Sub Genus -Serbecovirus,
  • Virus -2019nCoV or SARS-CoV-2

Coronavirus strands that affect humans

Coronaviruses infects mammals and birds there are total 7 known strands that infect humans including 2019nCoV, first 2 strands were detected in 1960’s

  1. Human coronavirus 229E (HCoV-229E)
  2. Human coronavirus OC43 (HCoV-OC43)
  3. SARS-CoV
  4. Human coronavirus NL63 (HCoV-NL63, New Haven coronavirus)
  5. Human coronavirus HKU1
  6. Middle East respiratory syndrome coronavirus (MERS-CoV), previously known as novel coronavirus 2012 and HCoV-EMC.
  7. Novel coronavirus (2019-nCoV). This is the strain that causes COVID-19 disease in humans

Covid-19 Pandemic

The first outbreak of the Novel Coronavirus or 2019nCoV in humans was confirmed and notified to WHO by China on 31/12/2019, when patients from Wuhan province of China were suffering with virus related non specific flu like illness from around 8/12/2019 then later the genome was sequenced to confirm this absolutely new and novel strain of coronavirus 2019-nCoV or SARS-CoV-2

Within three months of first reported case on 8/12/2019 the coronavirus outbreak that had first started from Wuhan in China had now reached more than 66 countries including India, Thailand, Japan, South Korea, Italy, Iran, Germany, Taiwan, Hong Kong, USA, Vietnam, Singapore etc. claiming more than 3100+ deaths of estimated 100000+ infected as on 8/3/2020. The death toll is constantly rising, in subsequent two months that is by 8/6/2020 almost 6.5 million got infected and almost 4lac deaths.

It will take some time to estimate mortality rate but it seems to be around 2%. Old people and people with other pre-existing disease condition are at higher risk of succumbing to death. With increasing death rate rises steeply with upto 50-70% death rate in symptomatic patients above 60 with hypertension or diabetes or other complications.

Most of the initial cases were from Huanan seafood market so epizootic origin is suspected.Outbreak of this particular strain of coronavirus is for the first time, So its new for human immune system. As the time lapses the affected community will start developing certain immunity against it, which will slow down the progress of transmission and epidemic as time lapses. Also with time and better understanding of virus and its epidemic, the health authorities will be more efficient in containing the disease and its epidemic.

There is a split between science community where in a group suggests that it has originated from snake where as other claims that snake cannot be the probable the reservoir and is probably from mammal reservoir mostly the bats as the genome sequencing shows 96% resemblance of bat coronavirus and 2019-nCoV.

It is postulated that homologous recombination of Clad A bat viruses “CoVZC45 and CoVZXC21” with some unknown Beta-CoV may have formed 2019nCoV

Human to human transmission of novel coronavirus was confirmed till mid January And the damage was done till then. The virus had started spreading at pace unmatched by any other disease witnessed in past 100 yrs.

PATHOGENESIS OF COVID-19 or Novel Coronavirus 2019 Infection

Still the pathogenesis is not been clearly understood but data and study results are fast pouring in and now we have some basic understanding about but there are many missing gaps and needs to be understood and filled up soon.

The Pathogen

The disease causing agent and its full geneome was sequence in December 2019-January 2020, soon after initial outbreak.It was found that the disease causing agent was a virus which had 70% genomic resemblence to SARS-CoV and 50% genomic resemblence to MERS- CoVand they termed it as Novel Coronavirus 2019 or 2019nCoV or SARS-CoV-2 and disease caused by this virus was termed as COVID-19.

Inoculation of 2019nCoV

From initial studies it seems that 2019nCoV attaches to the receptors of Angiotensin Converting Enzyme 2 (ACE2) through an endocytosis process trigerred with the help of spike protein present on surface envelop of the virus . Which are present good quantity on lymphocytes, macrophages, epithelial linning of respiratory mucosa, lungs alveoli, enodthelium of blood vessels, gastrointestinal tract and are also expressed by vital organ like heart and kidneys, which we see getting affected in this disease.

Multiplication and Spread of 2019nCoV

Virus not only has capability to attach to ACE2 receptors of upper respiratory tract and inoculate the cells but also has capability to actively replicate in upper-respiratory tract tissue which was demonstrated by isolating virus from swabs of upper respiratory tract with presence of Sub-Genomic mRNA (sgRNA) in cells of upper respiratory tract. There is tropism of upper respiratory tract and shedding of virus.

All of the above factors explains us fast and easy transmission of virus even in early stage of disease as compared to SARS-CoV and MERS-CoV.

Virus predominantly infects through upper-respiratory in majority cases and then gradually by 3-4 days it involves lower respiratory tract and then by second week there is wide spread invasion into bloodvessels and major vital organs like heart, kidneys with general viremia.

Immune Reaction Towards 2019nCoV Infection and Its Consequences

Its not only virus that causes damage to system but also the body’s immune response against the virus is causing damage to the body which is observed by excessive production of early proinflamatory mediators like Interlukine 6 (IL6) Tumour Necrosis Factor (TNF) Interlukine 1 (IL1), presence of inflamatory infiltrate in lungs. Reduced blood level of T-Lymphocytes and B-Lymphocytes although direct due to viral attack on these cells but also is attributed to redistritbution by immune respone which is demonstrated by presence of comparative more number of T-cell and B-cells at inflamatory sites.

The Cytokine Storm Postulate

There is much evidence to suggest that the initial immune response driven against virus causes activation of coagulation pathway which results in excessive production of early proinflamatory mediators which accumulate overtime leading to vascular hyperpermeability and micro-coagulations resulting from disturbed procoagulant-anticoagulant axis balance due to overt inflamatory response.

Thrombin, known for its primary role in coagulation by activation of platelets and conversion of fibrinogen to fibrin, also has multiple cellular effects that may enhance inflamatory response through Protinase-Activated Receptors(PARs).

Thrombin production is tightly controlled by negative feedback loops and physiological anti-coagulants like Tissue Pathway Factor Inhibitor, Antithrombin III and Protein 3. Inflamatory process can significantly reduce the concentration of anti-coagulants this deviates the fine balance of axis between procoagulant-anticoagulant balance that causes multiple micro-coagulations disseminated intravascular clots and multiple organ failure.

SIGNS AND SYMPTOMS of COVID-19

It shows symptoms that of severe respiratory tract infection giving rise to pneumonia with some gastrointestinal symptoms like other coronavirus infection, Its symptoms are much related to 2003 SARS Epidemic caused due to SARS-CoV.

Most of the patients remain asymptomatic and never get detected many show mild to moderate symptoms this forms the vast majority.

COVID 19 CLINICAL PRESENTATION

  • Almost 98% symptomatic cases of 2019-nCoV(Covid-19) infection presents with Fever
  • Dry Coughing is present in almost 82% of symptomatic cases.
  • Of all the cases sputum production is seen in 25-30% cases and Hemoptysis in upto 5% of all the cases.
  • Fatigue is observed in almost 70% cases approaching medical care
  • Muscle-aches (myalgia) in almost 44% of all the cases.
  • Headaches in almost 13% of all the cases
  • Diarrhoea experienced in 10% cases
  • Vomitting seen in 10% of all the patients
  • Almost 55% of all the cases will develop shortness of breath after 3-8days of initial general symptoms.
  • Almost 20% of all the the cases seem to progress into severe disease with respiratory distress symptoms within a day or two of developing shortness of breath.
  • Few patients go into shock and may develop cardiac arythmias.
  • Of all the cases less than 5-10%(approx) will die due to complications, mostly those who are elderly children or have other prevailing disease condition like diabetes, cardiac diseases, cancer etc.
  • X – ray and CT scan shows bilateral Lungs involvement with Ground Glass Opacities, grey white consolidated patches.
  • Leucopenia -Low WBC count especially lymphocytes – lymphopenia.
  • Increased Neutrophil to Lymphocytes Ratio(NLR)
  • Increased D. Dimer
  • Reduced Prothrombin time
  • Reduction in bleeding and clotting time.

SYMPTOM PROGRESSION

Window period of 2019-nCoV ranges between 2-14days. It takes 2-14 days for symptoms to appear post exposure to virus. Note the patient of 2019 nCoV (Covid-19) can spread infection to others even during this window period l, that is, even before any symptoms starts appearing after first inoculation of 2019-nCoV into body or even any test to decisively test positive.

After window period is over and the symptoms starts appearing the following pattern is seen in progression of clinical symptoms commonly found in most cases.

DAY 1-2 Initially on first 1-2 days patient will show mild fatigue malaise and heaviness of head with mild rise in temperature, few will show a peculiar symptom of Olfactory loss- loss of taste and smell(usually this type of presentation shows mild disease form and has has good prognosis).

DAY 2-3 Gradually the temperature will increase from 2-3rd day with mild irritation in throat.In many this symptom will stop increasing at this stage and will remain mild symptomatic throughout the course of disease, in rest it will progress with fever exceeding 100F, bodyaches, joint pains, weakness

DAY3-4 Fever continues to relapse with dry cough a very few minority might start showing development of shortness of breath even at this early stage.

DAY4-6 Loose motion is frequently encountered on once or twice between 4th and 6thday(in few minority it has appeared right on day one of initial symptoms) this might bring in weakness and exhaustion in patients and those with high fever may be drained even more by accompanying diarrhoea. Few might go into respiratory distress at this stage.

DAY 78 From 7th day onwards in few patients fever starts subsiding a bit but in many it persists and few go into respiratory distress.

DAY 8-9 Now 8th-9th days are important to observe as from here on majority patient’s immune system will develop sufficient immunity and resistance against virus and fight it off from the body and recover. Their fever breaks away and they start feeling better with weakness leaving their body but in few cases there is no recovery at this stage such patients progresses into critical stage either fever continues or breathlessness sets this is when the patient needs be urgently shifted to ICU.

WARNING SIGNS

  • Patients with co-morbidity like Diabetes Mellitus, Cardiovascular or Kidney diseases, Immuno-compromised, Organ failure, Asthma Bronchitis, Chronic Obstructive Pulmonary Disease(COPD),Cancer, Autoimmune diseases, Severe anaemia, etc.
  • Greater severity of pneumonia at presentation.
  • Elderly patients – Older the age greater the risk.
  • Radio-opacities and/or pulmonary infiltrates on X-ray findings
  • Neutrophil to Lymphocyte ratio (NLR) of more than 3.13
  • SPO2 level below 95%
  • Increased BUN or Serum Creatinine
  • Increased Liver enzymes SGOT SGPT, Bilirubin
  • Any neurological event
  • Increased D Dimer
  • Increased LDH
  • Reduced bleeding time
  • Reduced Clotting time
  • Reduced Prothrombin time
  • Transeminated intravascular clot.

COVID-19 DIAGNOSIS

There are two types of testing approach one is direct test and indirect test.

1) DIRECT TEST :-

Throat Swab for RT-PCR for SARS CoV-2

detects viral protein through Polymerase Chain Reaction PCR it is gold standard test as it amplifies/enhances virus protein to detectable levels and give most accurate results possible as we are directly detecting virus. But it is comparatively more costly and time consuming. Still it’s recomended as rapid antibody tests(indirect tests) that are available till date are too inaccurate to rely

2) INDIRECT TEST :-

Blood Test for Antibodies IgM and IgG against SARS CoV-2

Herebwe are not directly detecting the virus but we try to find out antibodies formed against 2019-nCoV/ SRAS CoV-2 virus. It is comparatively rapid in nature but not accurate. Presence of antibodies – IgM and IgG against SARS CoV-2 are indicators of past or active

Interpretation of blood test for diagnosis of Covid 19

  • RT-PCR -ve, IgM -ve & IgG -ve Means No current, No past infection or may be window period.
  • RT-PCR +ve, IgM -ve & IgG -ve means early infection no immune response developed
  • RT-PCR +ve, IgM+ve & IgG -ve suggests infection with early acute phase immune response developed.
  • RT-PCR +ve, IgM +ve & IgG +ve means later stage of infection with with longer lasting immune response developed.
  • RT-PCR +ve, IgM -ve & IgG +ve suggests acute phase of infection is recovered and virus is being neutralised and strong immunity is being developed.
  • RT-PCR -ve, IgM-ve & IgG +ve means infection has completely resolved and there is nonvirus in body and patient is non infectiois and has developed certain immunity towards virus for quite some time.

Time Line of Sensitivity of various Laboratory Investigations for Covid 19.

Day 0: Infected (innoculation)

Upto Day 5: Onset of symptoms(variable 2-21days, with 11.2days average)

Day 7: IgM positive – (from Day 7 toDay 21)

Day 14: IgG positive

Day 21: IgM disappears

Days 1-28: SARS CoV2 RNA & Antigens will be positive

Day 28: SARS CoV2 RNA & Antigens disappears

Disease Progression, Antibodies, Viral load, and Infectivity

Day 0 -Day 7: Window Period, Asymptomatic, Only PCR positive in this Phase, negligible Viral load on day 0-1 but viral load starts increasing very speedily and within a couple of days patient from mildly infectious on day 0 and 1, becomes considerably infectious and infectivity keeps increasing with each passing and in no time patient becomes highly infectious by the end of this period.

Day 7- Day 21: Symptomatic, both PCR and IgM Positive, Patient is highly infectious.

Day 14- Day 21: Decline Phase, PCR, IgM and IgG positive, Patient is highly infectious.

Day 21- Day 28: Convalescence Phase,IgM negative, IgG positive, PCR on declining count, Patient is still infectious.

After day 28: most of the patients are recovered and also PCR turns negative,so they are not infectious, IgG remains elevated,

OTHER TESTS

CT SCAN

Chest CT scan along with clinical picture and other blood tests like D.Dimer, CBC, NLR, ABG, CRP and ESR, LDH is also very important tool to give direction in diagnosis especially during pandemic when resources are less for RT-PCR. CT scan pattern may help to establish provisional diagnosis, during pandemic, which later can be confirmed by RT-PCR.

PREVENTION OF NOVEL CORONAVIRUS INFECTION DURING TIMES OF COVID-19 PANDEMIC

COVID 19 is caused by 2019-nCoV also called SARS-CoV-2. It is a highly contagious virus. The virus can spread even through casual contacts and proximity.

Current studies suggests that virus can survive on surfaces like glass, plastic, metals etc for may be up to 9days and in fecal material for may be upto weeks of which studies are still going on for confirmation.

It has spread to infect more than 63,00,000 person worldwide within a very short span of just 5months since its outbreak. Time and again most of the types of Coronavirus have proven themselves to have potential to create global pandemic claiming many lives within no time. Looking at the scale of pandemic and potential of 2019nCoV virus to spread very fast and claim lacs of lives in no time has spread panic and concern throughout the world as fast increase in cases of COVID-19 has overwhelmed the healthcare system even of the best country of the world with doctors finding them helpless against the disease and its scale and so almost all the major countries of the world have implimented partial or complete lockdown and social distancing norms to contain and slow down the spread of virus.

  • Keep distance from infected person, at least 6 feet of distance is recomended
  • Wear masks in public places
  • Avoid traveling to area affected with 2019-nCoV epidemic
  • Quatrantine patients traveling from COVID-19 epidemic regions.
  • Avoid contact with person known to have came in contact with any person infected with 2019-nCoV or travel history from affected area.
  • Report any case of cough, cold, fever or symptoms of flu to health authorities found in all the regions where cases of SARS-CoV-2 also called 2019-nCoV is prevailing.
  • Person staying in affected regions should stay within their home and avoid any public places as much as possible.
  • While moving out in affected region, wear removable and easily washable overcoats, wear disposable gloves, protective eye wears.
  • Touching with bare hands to public handle, buttons, walls curtains and other objects in public places in affected region should be avoided.
  • When in public place, try to prefer option with open air and lesser crowd then in enclosed public premises.
  • Dont use public transport unless its unavoidable.
  • Stay away from sewage channels and fecal material.
  • Prefer food prepared at home that too fully cooked and avoid uncooked raw food.
  • Avoid gathering and meeting people during times of epidemic.
  • Avoid hand shakes and close proximity with other people during epidemic.
  • Maintain healthy lifestyle and nutrition, food rich in Zinc, Iron and Vitamin C is recomended
  • Keep all rooms highly ventilated.
  • Sanitize your hands frequently almost every 1-2hours, wash hands at least for 20seconds at a time.
  • People with long hairs should keep hair in such a way that it doesn’t come in contact with potentially infected objects in public places e.g. handle on seat back on buses and trains.
  • Eat nutritious food, daily yoga and exercise sufficient exposure to sunlight, timely meal sleep and exercise helps boost health and immunity to prevent and fight the disease.

When and how to use mask correctly is explained and demonstrated in the video below by WHO

When To Use Mask Explained in Video released By World Health Organisation
When and How to use mask and precautions while using mask explained in detail with procedure of wearing and removing mask by WHO.

HOMOEOPATHIC MEDICINE ARSENICUM ALBUM 30 PREVENTIVE MEDICINE AGAINST CORONAVIRUS DURING COVID -19 PANDEMIC

Expert committee of MINISTRY OF AYUSH, GOVT OF INDIA has identified Arsenicum Album 30 as Genus Epidemicus for immunity enhancement during COVID-19 pandemic and has recomended issuing public notice regarding the same. It has also recomended registered homeopathic practioners of India to suggest identified COVID-19 Genus Epidemicus Arsenicum Album 30 to people as immunity enhancement during the COVID 19 pandemic.

As per Ministry of Ayush, Govt of India Circular:-

Central Council for research in Homeopathy and Ministry of Ayush on its 64th Scientific Advisory Board meeting date 28th January 2020, recomended that Arsenicum Album 30 could be taken as prophylactic medicine against coronavirus infection in following prescribed dose

  • One Dose of Arsenicum Album 30 on Empty Stomach For 3 Consecutive Days
  • The Dose Should Be Repeated After One Month Following The Same Schedule.

Other Precautions that needs to be followed during homeopathic medication

  • Do not eat or drink anything at least for 1 hour after taking medicine. Plain water or milk at room temperature could be consumed during this one hour if required.
  • Brush Teeth at least one hour before or after taking this doses i.e one hour interval prior and after the dose.
  • Avoid Uncooked Onion, Uncooked Garlic and Coffee atleast for 5 days when you start medicines.

Govt. Of India, Ministry of AYUSH suggests Homeopathy for prevention and treatment of 2019novel coronavirus Covid-19. https://pib.gov.in/PressReleasePage.aspx?PRID=1600895

Ministry of AYUSH, Government of INDIA advisory for prevention of Coronavirus 2019nCoV section picture
Govt of India, Ministry of AYUSH coronavirus homeopathic preventive medicine advisory section picture

Homeopathic Medicines Indicated For COVID-19 Novel Coronavirus Infection

As per my view other than basic symptomatic supportive treatment and available regular conventional allopathic treatment, homeopathic medicines can be used in conjunction, as per indication under guidance and observation of both qualified homeopathic physician and allopathic physician.

Few of the Homeopathic medicines that can be useful in treatment of COVID-19 that is SARS-CoV-2 infection also called 2019 novel coronavirus infection are listed below.

ACONITUM NAPELLUS

Initial stage of fever or first day of symptoms in patients much fear and anxiety. Also this medicine can be used for patients having psychological problems of fear fright and anxiety due to COVID-19 pandemic and lockdown psychological effects.

BELLADONNA

This remedy may prove useful for heaviness of head, fever and bodyaches in COVID-19

ARSENICUM ALBUM

This is wonderful drug used since ages to treat respiratory complaints be it asthma, allergic rhinitis, viral respiratory infections or bacterial respiratory infections. Arsenic is consumed by mountaineers since ages which helps them to survive in higher altitudes in low oxygen environment it shall work well in any stage of Covid 19 infection. Itcan also be brought into service in patirnt with breathlessness and respiratory distress. Arsenicum Album acts not only on respiratory sphere but also gastrointestinal sphere which should cover the sptom of diarrhoea that many Covid-19 patients present along with respiratory and general symptoms. It should work well in Covid 19 patients with weakness where the patient is mentally restless but physically too weak to move.

USE OF ARSENICUM ALBUM AS HOMEOPATHIC GENUS EPIDEMICUS TO ENHANCE IMMUNITY AGAINST CORONA VIRUS DURING COVID-19 PANDEMIC

ARSENICUM ALBUM 30 is being identified as Genus Epidemicus and is suggested by Ministry of Ayush, Government of India under consultation of Central Council For Research in Homeopathy that it could be taken as prophylactic against Coronavirus infection one dose every morning on empty stomach for three consecutive days and same protocol should be repeated after a month of the epidemic still prevails in the region.

ARNICA MONTANA

Cytokine-Storm is associated with increased capalilary permeability and disemminated intravascular coagulation due to overproduction of early-proinflamatory cytokines causing imbalance in procoagulant-anticoagulant balance causing microcoagualations in complicated cases of COVID19.

Arnica Montana is commonly used medicine in homeopathy to dissolve internal clots by stimulating body’s natural pathways to dissolve clots and in inverse concentration un-homeopathically it is also used to form clots stop to stop bleeding. So Arnica Montana has both the type of effects procoagulant and anticoagulant depending on what concentartion and repetition its uses. So with correct homeopathically succussed dilution and correct posology it may prove useful in such acute life threatening situation condition of sudden cytokine storm which causes dissemminated intravascular coagulations with damaged leaky hyperpermeable capillaries .

BRYONIA ALBA

This medicine works well in cases who are living in region where days are hot and nights are cold. dry coughing, shortness of breath, fever, body aches, muscle aches are some of the symptoms covered by bryonia in COVID-19 patients. Master Hahnemann recommends bryonia alba in epidemics during summer season affecting respiratory system.

CAMPHORA

Camphora made from camphor can be used in terminally ill COVID-19 patient with gross signs of circulatory insufficiency, cyanosis, hypoxia and this should be the first medicine brought in immediately administered in cases of sudden collapse. Typically it has to be used in higher potency as recomended by some homeopaths.

AGARICUS MUSCARIUS

Agaricus muscarius typically used in homeopathy for frosbite and cyanosis of extrimities can prove beneficial in terminally ill COVID-19 patients with signs of cyanosis and bluish discolouration of extremities like finger and toes this homeopathic medicine should be called in for service.

CRATEGUS OXYACANTHA

crategus oxyacantha may prove of great service in COVID-19 patients having cardiac complaints and high lipid profile having circulatory distress and disseminated intravascular coagulations crategus should be thought of is complimentary and supportive medicine.

ASPIDOSPERMA QUEBRACHO

Aspidosperma Quebracho successfully used in homeopthic mother tincture form since ages for treatment of acute exacerbations of asthma and cardiac asthma may prove useful in COVID-19 patients that has cardiac complaint and develop Cardiac Asthma.

ANTIMONIUM TARTARICUM

Antimonium Tartaricum shall prove useful for COVID-19 patients living in region with high humidity near sea-shores works wonders in relieving rattling cough with thick mucous especially in aged.

KALIUM BICHROMICUM

Kalium Bichromicum is very commonly used medicine in homeopathy which is helpful in getting rid of thick stringy ropy mucous it may prove of great service in COVID-19 cases with accumulation of thick mucous difficult to bring up.

JUSTICIA ASHATODA

Justicia Adhatoda also known as Vasaka in indian medicine and iss used in Ayurveda since ages. It is a great expectorant if used in lower potency preferably in homeopathic mother tincture form.

THALASEMIA

Thalasemia is a genetic disorder where in mutation or deletion in any genes responsible to produce globin chain of haemoglobin results in abnormal haemoglobin production.

Normal adult has Haemoglobin A (HbA). HbA is a hetrotetramer of two α globin chains and two β globin chains. In normal humans there are total 4 genes (2pairs) for production of αglobin chain and 2 genes(1 pair) for production of β globin chain. When there is defect in genes producing α globin or β globin chains of heamoglobin it results into thalasemia.

TYPES

  • Alpha Thalasemia – Abnormal or dhieficient α globin chain production
  • Beta Thalasemia – Abnormal or deficient β globin chain production.
  • Delta Thalasemia – Abnormal or defective delta chain production.
  • Thalasemia in combimation with other haemoglobinopathies like – Haemoglobin S , Haemoglobin E, Haemoglobin C, Haemoglobin D.

Of the above all types the most common types alpha and beta are discussed below.

ALPHA THALASEMIA

Alpha Thalasemia has defective α globulin chain production. Genes responsible to produce α globin chain are situated on chromosome 16. HBA1 and HBA2 genes are responsible for production of α globin chain. Both the genes are acquired from both the parents so total two HBA1 and two HBA2 genes. So, there are two genes acquired from each parent making total 4 genes or two pairs(αα/αα) responsible to produce α globin chain.

Depending upon number of gene deleted the condition is classified into 4 categories

  • α Thalasemia Silent (1 gene deletion)
  • α Thalasemia Trait (2 gene deletion)
  • HbH disease (3 gene deletion)
  • Hb Bart Syndrome (all 4 gene deletion)

Alpha Thalasemia Silent

Any one gene deletion (-α/αα), one of the two allele not received from one parent. Usually there are no sign of anaemia as the remaining three genes produce sufficient alpha globin chains. Althought they dont show symptoms they are the silent carrier and if married to person with one or more α globin making gene deletion then some of their offsprings will have symptoms, probability and severity of the disease in the offsprings will depend on number of gene deletion in the partner.

Alpha Thalasemia Trait

Any two gene deletion, it can be of two genotypes as descussed below, this type shows mild anaemia symptoms.

  1. Two gene deletion – homologous; one of the two allele not received from each parent(-α/-α).
  2. Two gene deletion- heterologous; both the alleles not received from one parent (–/αα).

HbH Disease

Three gene deletion (–/-α) No copy of gene received from one parent and only one of the two copy received from another parent. These causes very low α chain production resulting into excess proportion of β chains causing formation of unstable haemoglobin tetramer made up of 4 β globin chains, instead of two α and two β. This type of haemoglobin with all 4 globin chain of β globin is called HbH which is very unstable. These individuals shows moderate to severe anaemia and other thalasemia related symptoms.

Hb Bart Syndrome

All four gene deletion (–/– )No copy of α chain producing gene received from either of the parent. It is a fatal condition where in there are no α chains produced and results into severe fetal condition called hydrops fetalis. Death ensues soon after birth.

BETA THALASEMIA

Beta thalasemia has defective β globin chain production. For production of β globin chain there is only one gene acquired from each parent makin it total one pair(β/β) i.e total 2 genes responsible to produce β globin chain. Gene Responsible for production of β globin chain is called HBB and is located on chromosome 11.

Beta Thalasemia Minor

  1. (b/β) One gene received from a parent is altered and the one from other parent is normal.
  2. (-/β) No gene received from a parent and the gene received from another parent is normal.

Beta Thalasemia Intermedia

  1. (b/-) One copy of gene received from a parent altered and one from another parent is absent.
  2. (b/b) Genes received from both the parent are altered.

Beta Thalasemia Major

  • (-/-) No genes producing β globin chain received from either parent.

SIGNS AND SYMPTOMS

Symptoms and its severity depends upon the above mentioned severity of genotype the individual has few complaints which patient with this disease condition show are mentioned below.

  • Anaemia
  • Iron Overload
  • Bone deformities
  • Enlarged spleen
  • General growth is slow
  • Ferquent Infections
  • Cardiac complaints

DIAGNOSIS

  • Complete blood count
  • Hb Electrophoresis
  • DNA analysis.

HOMEOPATHIC TREATMENT AND INDICATED HOMEOPATHIC MEDICINES FOR THALASEMIA

  • Cinchonna Officinalis
  • Abrotanum
  • Natrum Muriaticum
  • Phosphorus
  • Calcarea Phosphorica
  • Calcarea Carbonica
  • Calcarea flourica
  • Ruta Graveolens

LYMPHOMA

LYMPHOMA – Malignant neoplasm of lymphoid tissue is called Lymphoma.

They are type of blood cancers where in there is abmormal cell-proliferation of Lymphoid Tissue.

Lymphomas and Leukemias both fall under a broader category “Malignant Neoplasms of Lymphoid and Heamatopoetic Tissue” or cancer of Lymphocytes”. Wherein unlike Leukemias, the term Lymphomas is precisely restricted only to the Tumours of Lymphoid tissue.

Types of Lymphoma

  • Hodgkin’s Lymphoma
  • Non Hodgkin Lymphoma
  • Multiple Myeloma
  • Immunoproliferative diseases

RISK FACTORS

Hodgkin’s Lymphoma

  • Hereditary
  • Epstein Barr Virus Infection

Non Hodgkin’s Lymphoma

  1. Autoimmune Conditions
  2. HIV infection/AIDS
  3. Human T-Lymphotropic Virus Infection
  4. Immunosupressive Medication
  5. Exposure to certain Pesticides
  6. Tobacco Smoking

SIGN’s AND SYMPTOM’s

  • Lymphadenopathy
  • Pel-Ebstein Fever – Intermittent Fever of around 38C lasting for 1-2weeks and relapsing again after days to weeks
  • Weight loss of more than 10% within 6 months.
  • Profuse perspiration especially at night.
  • Anorexia – loss of appetite
  • Weakness and fatigue
  • General Pruritus
  • Dyspnoea on slightest exertion

Ann Arbor Staging System

Principle Stages

  • StageI – Single Lymphnode and surrounding area involved
  • StageII – Two areas involved a lymph node and another area and both are on the same side of daiphram either above or below
  • StageIII – Affected areas on both the sides of daiphram with one organ or region near lymphnode or spleen
  • StageIV – Diffused and disseminated with more than one Extra-Lymphatic organ involved incliding Liver, Bone Marrow, nodular involvement of Lungs.

Modifiers

  • A or B – type symptom – When patient has following three constitutional symptoms then patient is categorised into B-type symptoms 1) Pel-Ebstein Fever. 2) Weight loss and 3)Night Sweats. When there are no above mentioned combination of B-type constitutional symptoms present then patient is categorised into A type.
  • S ” – Disease with Slpeen involvement is denoted with S modifier.
  • ” E” – When disease involves extranodal region that is region surrounding the lymphnodes it is denoted with E modifier.
  • “X” – X is denominated when the largest bulky deposit region is more than 10cm or if more 35% area of chest is occupied by mediastenum on X-Ray.

Nature of Stage

  • Clinical Staging “C.S.” – C.S. Mentioned when staging is done based on clinical examination and test.
  • Pathological Staging “P.S.” – When Staging is done based on pathological findings through invasive techniques like surgical excision etc its Mentioned as P.S.

DIAGNOSIS

Biopsy of Lymph node to confirm Lymphoma.

Further to classify Lymphoma:

  • Immunophenotyping
  • Flow Cytometry
  • Fluorescence in-situ Hybridisation.

CT scan and PET scans helps us evaluate extent of spread of the condition and its staging.

HOMEOPATHIC MEDICINES FOR HODGKIN’s LYMPHOMA and NON- HODGKIN’s LYMPHOMA

  • BARYTA CARBONICA
  • CALCAREA CARBONICA
  • CINCHONNA OFFICINALIS
  • CALCAREA FLOURICA
  • CONIUM MACULATUM
  • PHYTOLACCA
  • BARYTA MURIATICUM
  • TUBERCULINUM
  • CALCAREA PHOSPHORICA
  • CALCAREA CARBONICA

LEUKEMIA

Abnormal proliferation of blood cells due to defective medullary heamatopoetic stem cells is called leukemia.

In Layman terms, defective bone marrow causes uncontrolled multiplication and abnormal growth of cells that are components of blood causing blood cancer.

TYPES AND CLASSIFICATION

Based on speed of progression and maturity level of most cells most of the Leukemia can be categorised into

  • Acute – Fast progressing takes weeks to few months, Most of the cells are blast cells (immature cells), Requires immediate treatment, Commonly seen in children.
  • Chronic – Relatively slow progressing takes months to years, has relatively mature cells, patient usually inder observation before commencing any aggressive treatment, Common in elderly people.

There are some leukemia which do not follow fixed pattern also presentation of symptom may vary in different individual and also there are cases where in they change the classical course of and speed of progression.

Based on types of cells involved, most of the Leukemia can be categorised into

  • Lymphoid (Lymphocytic) – Precursors of Lymphocytes are involved. It is further classified as per which lymphocytes are involved wether B-cells or T-cells.
  • Myeloid(Non-Lymphocytic) – Precursors of RBC, Non-Lymphocyte WBC and Platelets are involved.

A Lymphoid or Myeloid leukemia can Either Acute or Chronic as described below

  1. Acute – Lymphoblastic(ALL)
  2. Chronic – Lymphocytic (CLL)
  3. Acute – Myeloid (AML)
  4. Chronic – Myeloid (CML)

ACUTE

Acute Lymphoblastic Leukemia (ALL) –

When there are multiple mutations in the locus, that control cell proliferation, cell maturation and cell death of precursor cells of Lymphocytes called Lymphoblast then this results in ALL. ALL can be of T cell type or B cell type.

Genes associated with ALL –

  • KMT2A – Infant ALL – onset before 10yr of age
  • ARID5B
  • CKDN2A
  • CKDN2B
  • TP53
  • GATA3
  • PIP4K2A
  • IKZF1
  • CEBPE
  • PAX5 – Inherant Autosomal Dominant
  • ETV6 – Inherant Autosomal Dominant

Certain syndromes that increases risk of ALL

  • Down’s Syndrome
  • Bloom Syndrome
  • Fanconi Anaemia
  • X-Linked agamaglobulinaemia
  • Neurofibromatosis Type 1
  • Li-Fraumani Syndrome
  • Paroxysmal Nocturnal Heamoglobinuria
  • Severa Combined Immunodeficiency
  • Costmann Syndrome
  • Ataxia Telangiectasia
  • Schwachmann Daimond Syndrome

SUBTYPES OF ALL

  • Precursor B-cell ALL
  • Precursor T-cell ALL
  • Mature B-cell ALL(also called Burkitts Leukemia due to its similarity with Burkitts Lymphoma)
  • Acute Biphenotypic Leukemia.

Acute Myeloid Leukemia (AML)

It is an acute Non-Lymphocytic type of malignanacy which involves myeloblast cells(precursor of monocytes and granulocytes).

In AML there is mutation of genes that mature and differentiate the myeloblast cell will arrest maturation and differentiation and the cell will freeze in undifferentisted immature state and when this type of mutations combined with mutations in genes controlling proliferation in same cell will result in clonning of immature undifferentiated cells resulting in AML

Genes associated with AML

Subtypes of AML

Subtypes of AML are classified based on staging of maturation i.e. at which stage the msturation of the cell is arrested and how is the general behaviour of cells and which genes are involved.

  • Undifferentiated Acute Myeloblastic Leukemia
  • Acute Myeloblastic Leukemia with Minimal Maturation
  • Acute Myeloblastic Leukemia with Maturation
  • Acute Pro-Myelocytic Leukemia (APL)
  • Acute Myelomonocytic Leukemia
  • Acute Myelomonocytic Leukemia with Eosinophilia
  • Acute Monocytic Leukemia
  • Acute Erythroid Leukemia
  • Acute Megakaryoblastic Leukemia

Adult T-Cell Leukemia

Blast Crisis of CML

CHRONIC

Chronic Lymphocytic Leukemia (CLL)

  • B-cell Pro-Lymphocytic Leukemia(B-PLL)
  • T-Cell Pro-Lymphocytic Leukemia(T-PLL), T-PLL doesnt completely fit into this category.

Hairy-Cell Leukemia(HCL)

Large Granular Lymphocytic Leukemia(LGLL)

Chronic Myeloid Leukemia (CML)

  • Chronic Granulocytic Leukemia
  • Juvenile CML
  • Chronic Neutrophillic Leukemia
  • Chronic Myelo-Monocytic Leukemia(CMML)
  • Atypical CML (aCML)

Chronic Eosinophillic Leukemia

Few other types, preleukemias and syndromes that cannot be classified in above category

  • Clonal Eosinophilia
  • Other Myelodysplastic Syndromes
  • Other Myeloproliferative Syndromes

CAUSES

Leukemia is caused due to mutations in genes that are associated with proliferation, differentiation, growth, maturation and cell death of blood cells. With different types of mutations responsible for different types of leukemia.

These genetic mutations can be inherited or acquired due to multiple reasons of which few known risk factors are

  • Exposure to certain chemicals (e.g. benzene, petrochemicals, hair-dyes, agent orange herbicide, certain insecticides)
  • Radiation – ionising radiations and doubtedly non-ionising radiations too.
  • Smoking and tobacco use.
  • Prior alkylating chemotherapy for some other form of malignancy.
  • Viruses – Human T-cell Lymphotropic Virus – 1 HTLV-1 is associated with Adult T-cell Leukemia and Hepatitis C is associated with CLL
  • Diseases and Syndromes – Down’s Syndrome, Kline Felter syndrome, Fanconi Anaemi, Ataxia-Telangiectasia or Louis-Bar Syndrome, Myelodysplastic syndrom, Myeloproliferation syndrome.

Few of these factor are seen responsible for specific type of cancer (eg HTLV1 causes Adult T-cell Leukemia, Tobacco and Down’s Syndrome increases risk of AML).

SIGNS AND SYMPTOMS

Symptoms may vary in different types of leukemia, different individuals and different stages of disease.

  • Tired feeling
  • Paleness due to anaemia
  • Shortness of breath
  • Headache, lethargy, stiffness of neck
  • Loss of appetite
  • Weight loss
  • Tendency to catch infection too frequently
  • Fever usually due to secondary infections
  • Painful long bones
  • (Heamorrhagic diathesis) easily bleeds and frequent ecchymosis and petechiae (bruises).
  • Painless lymphomegaly (Enlarged lymphnodes)
  • Hepatospleenomegaly – can easily palpate liver and spleen due to its increased size.
  • Fibrosis of bone marrow
  • Chloroma or Leukemia Cutis or myeloid sarcoma or granular sarcoma or extramedullary myeloid tumour
  • Swollen painfull and bleeding gums
  • Sweet’s Syndrome
  • Pitting Oedema
  • Enlarged Testis
  • Mediastinal mass
  • Cranial nerve Paralysis if CNS is involved
  • Increased blood cell count , WBC or RBC or Platelets, depending on type with most if the cells immature and lacking differentiation.

DIAGNOSIS

  • Complete Blood Count
  • Bone Marrow Biopsy
  • Lymph Node Biopsy

HOMEOPATHIC TREATMENT WITH INDICATED HOMEOPATHIC MEDICINES

  • Arsenicum Album
  • Phosphorus
  • Hekla lava
  • Lachesis
  • Benzinum
  • Carica Papaya
  • Cinchonna Officinalis
  • X-ray
  • Thuja Occidentalis
  • Syphillinum
  • Baryta Carbonica
  • Calcarea Phosphorica
  • Ruta Graveolens
  • Calcarea Fluorica
  • Calcarea Carbonica
  • Symphytum Officinalis
  • Hyocyamus Niger
  • Medhorrhinum

UNDER CONSTRUCTION

MYCOSIS FUNGOIDES

Mycosis Fungoides is a type of Non-Hogkin Lymphoma. It is the most common type of Cutaneous T-Cell Lymphoma(CTCL).

Mycosis Fungoides is a misnomer which means “Mushroom-like fungal disease” but by no means it is a fungal condition. It is a type of blood cancer caused due to unusual expression of Skin-associated CD4 T-Cells. This cancer affects skin and produces various lesions on skin and rarely metastatise in other tissues.

It is a fatal condition with 10year survival rate of less than 70% which is even less in elderly.

It usually appears in people above 20years of age and is more common after age of 50yrs , males are affected more than females, the disease tends to be more fatal in black race. Survival rate has been found good in married white women.

CAUSES

Causes of Mycosis Fungoides remains unclear

No hereditary or genetic factors have been found associated to the disease.

It is considered to be non-contagious but some studies suggest that Human T-cell Lymphotropic Virus is associated with this condition.

SYMPTOMS

Initially disease shows symptoms that are not distinguishing and in most of the cases it resembles psoriasis or eczema. Even on biopsy it can not be diagnosed easily in early stages. Even in later stages multiple biopies are required to establish diagnosis.

Disease presentation begins from skin as exfoliating, pruritic, erythodermic eruptions resembling to Eczema or Psoriasis and is almost always mistaken initially in most cases. These eruptions tends to appear first on buttocks in vast majority of cases and then spreads throughout the body. Pruritus is present in only 20% of all the cases. In later stages tumourous and ulcerative lesions may also appear. Disease usually in most cases starts appearing at around age of 45-50 and is a slow prohressing condition with and its usually around age of 60+ that mist patient starts presenting symptoms of later stages like tumours, generalised pruritus and erythrodrema and ulceration. Though in many cases it may start as early as age of 20 and rarely before 20yrs of age. The diseases is classified into three stages

Stages of Mycosis Fungoides

Mycosis fungoides is divided into three stages viz.

  1. Pre-Mycotic
  2. Mycotic
  3. Tumourous

Pre Mycotic Stage

It starts appearing on skin at this stage as erythematous, pruritic, exfoliating skin eruptions.

On biopsy it cannot be diagnosed at this stage as histopsthology shows pattern of non specific dermatosis with epidermal psoriasiform changes.

Mycotic Stage

In Mycotic stage Infiltrative Plaques starts appearing as slightly raises or wrinkled spots.

On histopathology polymorphs and few atypical lymphoid cells are seen inflamatory infiltrates in dermis. When this cells are seen lined up.in epidermal basal layer without spongiosis then its confirmatory finding to establish diagnosis of mycosis fungoides.

Tumorous Stage

Nodular overgrowths are seen on skin ranging from few milimeters to centimeters scattered throughout the body along with plaques and patches. Usually it appears on the same place where the plaques and patches are. Also there is erosion of the tumours and ulcerations is seen in many cases over the tumour and plaques.

On histopathology they show medium sized lymphocytes with cerebroid nuclei expands dermis.

DIAGNOSIS OF MYCOSIS FUNGOIDES

Diagnosis is based primarily on histopathological findings of the skin lesions

Clinically patients showing features suggestive of or doubted mycosis fungoides are closely monitored over the time untill biopsy confirms. Multiple boipsies of various lesions might be required at every progressing stage untill confirmed, as its very difficult to estsblish diagnosis in initial stafe wether clinically or histopathologically as it resembles psoriasis or eczema.

On histopathology following findings are required to establish diagnosis of mycosis fungoides

  • Band-like lymphocyte infiltrate in superficial papillary dermis
  • Epidermotropism
    • Cerebroid T-cells in dermal and epidermal infiltrate
  • Pautriers Microabscesses – though not present in most cases but is characteristic finding of mycosis fungoides where in the epidermal infiltrate shows atypical lymphocytes arranged in aggregates of four or more.

HOMOEOPATHIC MEDICINES FOR MYCOSIS FUNGOIDES

  • Thuja Occidentalis
  • Syphillinum
  • Antimonium Crudum
  • Arsenicum Album
  • Ars Sulph Flavum
  • Phosphorus
  • Argentum Nitricum
  • Hepar Sulphuris
  • Sulphur
  • Silicea

EPILEPSY

Epilepsy is condition where in abnormal paroxysmal hyper-synchronous electrical changes within brain causes unpredictable, sudden and repetitive spells of seizures.

CAUSES OF EPILEPSY

  • Neurodegenerative Diseases
  • Brain Injury
  • Infections of Central Nervous System
  • Stroke
  • Brain Tumour
  • Birth defects
  • Etc

It can be due to any structural or physiological abnormality within brain caused due to genetic mutations, injuries, infections, diseases, tumours and other unknown factors. Cause for epilepsy in many cases remains unknown.

SIGNS AND SYMPTOMS OF EPILEPSY

ICTAL STAGE OR SEIZURE

Epilepsy is caharacterised by different patterns of seizures.It is a state of sudden onset of varried degree of involuntary muscular stiffness or relaxation or combination of both with varied degree from mildly altered to complete loss in sensations and consciousness due to abnormal electrical changes within brain.

General Signs of Seizure

1)Outwardly seen signs

  • Complete stiffness of body due to contraction of muscles of body Or
  • Complete relaxation of body muscles Or
  • Contraction with relaxation causing twitching and jerking of body.
  • Suddenly losing and regaining of consciousness
  • Eyes turned ind fixed in one direction
  • Fixed, dilated or contracted pupils
  • Locked jaws, causing bitting of tongue between teeth, causing severe injury on tongue and bleeding.
  • Excessive salivation and froth from mouth
  • Excessive Perspiration
  • Involuntary passage of urine
  • Clenched thumbs
  • Etc

2) Signs Within felt only by the patient

  • Strong abnormal smells
  • Strong emotional swings
  • Phobic state
  • Tingling sensation in toes and fingers
  • Rising sensations in abdomen
  • Etc

Epilepsy patient may show varried pattern of symptoms, depending upon type of seizure, which is dependent on which region of brain is involved. Below is the classification of types of seizures

Types of Seizures

I)Focal or Partial Seizures

One Hemisphere or One lobe is involved it can be classified into two types:

  1. Simple Partial – Patient remains conscious, that is aware, realises and understands that something is happening is somewhat responsive, can recollect what had happened(during seizure), comparatively smaller region in brain is involved, patients feels strange sensations, jerking movements.
  2. Complex Partial – Patient loses consciousness completely or loss of awareness and responsiveness, may not be able to recollect episode of seizure or what had happened then.

2)Generalised Seizures

Both the hemisphere are involved, these type of seizures are classified into six sub-types

  1. Atonic – Also called drop seizure or akinetic seizure. Partial or complete loss of muscle tone and control especially of trunk muscles causing patient to fall forwards with head leaning forwards causing injury. Atonic seizures usually doesnt last more than fifteen seconds in some cases followed by paralysis in a muscle group not lasting for more than three minutes. Usually the onset in most cases is during childhood and may persist into aldulthood. All the cases of concurrent Atonic seizures with onset during childhood needs to be carefully evauated for Lenox-Gustaut Syndrome (LGS) characterised by concurrent episodes of either atonic or tonic seizures with cognitive disorders and spikes on electroencephalogram. LGS a rare, complex and fatal condition usually caused due to congenital infections, genetic disorders like Tuberous Sclerosis and West Syndrome, many other genetic mutations, brain lesions. Atonic seizures are also found in Dravets Syndrome.
  2. Tonic – Sudden stiffness due contractions of muscles of limbs and trunk causing patient to fall backwards which may result into injury due to fall, it often occurs in state of sleep as well. These type of seizures usually do not last for more than 20 minutes. Tonic seizures are one of the most commin type of seizures associatex with Lenox -Gustaut syndrome as mentioned above.
  3. Clonic – Sustained uncontrolled violent rythmic jerking of body parts due to rapid contraction and relaxation of muscles, cant be stopped even by exerting force. This type of seizures are also refered as convuslions.
  4. Tonic-Clonic – Tonic and Clonic pattern of seizures follows each other randomly in phases. In Tonic phase the muscles suddenly contracts and body stiffens followed by clonic phase when suddenly patient’s body starts jerking violently in rythm due to rapid contraction and relaxation of muscles.
  5. Myoclonic – Jerking and Twitching of group of muscles. Usually patient is conscious. This type of seizures are seen in many conditions amd syndromes like LGS(mentioned above), juvenile myoclonic epilepsy (usually appears during puberty, morning seizures usually after patient wakes up usually involves neck and upper limb), Progressive Myoclonic Epilepsy(rare syndrome of combination of Tonic-Clonic and Myoclonic)etc.
  6. Abscense – In this type patient suddenly lose conscious and soon regiains consciousness with no other evident external signs except patient suddenly stops and become stand still and visibly , for others, outwardly they seem as if lost out in thought for a while.

Secondary Generalised Seizures

Starts as partial seizure and progresses as generalised seizure. It is termed as secondary generalised seizure, as the primary event was initial partial seizure and then it progressed to generalised seizure.

Status Epilepticus

When seizures fail to stop and keep continuing for more than 5 minutes, usually the seizure pattern is of Tonic-Clonic type. Its a medical emergency and may prove fatal if not treated immediately

POST-ICTAL STATE

  • Confussion lasting for few munuted to couple of hours.
  • Paralysis of limbs one sided, lasting for upto 15 hours and may take upto 2 days for complete recovery, it is called Todd’s Paralysis.

DIAGNOSIS OF EPILEPSY

  • MRI
  • CT Scan
  • EEG
  • And may require many other tests to find out underlying cause of epilepsy.

HOMOEOPATHIC MEDICINES FOR EPILEPSY

  • TARRENTULA HISPANICA
  • STANNUM METALLICUM
  • BELLADONNA
  • GELSEMIUM SEMPERVIRENS
  • AETHUSA CYNAPIUM
  • PLUMBUM METALLICUM
  • ZINCUM METALLICUM
  • LACHESIS
  • NAJA
  • STROMONIUM

SEPTIC ARTHRITIS

Septic Arthritis is invasion of joint by micro-organisms causing inflamation, it is also called infection of joint or Arthritis due to infection or infective arthritis.

CAUSES

VECTORS

Septic Arthritis can be caused due to infection of any of the following vectors

  • Bacteria
  • Virus
  • Fungus
  • Parasite

Most Common Organisms Known to Cause Septic Arthritis.

  • Staphylococci – Methycillin Resistant Staphylococcus Auris(MRSA)
  • Streptococci
  • Escherichia Coli
  • Pseudomona Aeruginosa
  • Neisseria Gonorrhoeae
  • Neisseria Meningitidis
  • Myocbacterium Tuberculosis
  • Salmonella spp.
  • Brucella spp.
  • Eikenella Corodens
  • Pasteurella Multocida
  • Borrelia Burgdorferi
  • Rubella virus
  • Parvovirus B19
  • Chickungunya virus

RISK FACTORS

Usually its not common to get joint infection unless the immunity of a person is weak or there is history of surgery, prosthesis, deep tissue infections etc.

  • Joint Surgery
  • Prosthetic implants
  • HIV
  • Immuno-suppressive Medication
  • Intravenous drug users
  • Rheumatoid Arthritis
  • Osteoarthritis
  • Arthritis due to Gout
  • Gonorrhoea
  • Infective Endocarditis
  • Deep and /or nonhealing wounds
  • Other deep tissue infections
  • Other causes of septicemia
  • Old age

SIGNS AND SYMPTOMS OF SEPTIC ARTHRITIS

  • Usually single joint is infected, less frequently more than one joints are involved.
  • Most commonly involved joint is knee joint and other freqently involved joints are hip, spine, shoulder, wrist, elbow, sacroilliac and sternoclavicular joints.
  • Sudden onset of symptoms, fast progression of disease.
  • Swelling, redness with increased local Heat and pain around joint. Swelling and redness is comparatively much more than other types of arthritis.
  • Fever with or without chills and headache.
  • Cant move joint due to severe pain.
  • Pain aggravated in slightest motion or jarring, pain is ususally aching type with stitching, stinging and pulsating.

DIAGNOSIS OF SEPTIC ARTHRITIS

  • Athrocentesis – microorganisms usually found on culture, WBC count above 50,000-1,00,000/cubic mm, neutrophils more than 90%, lactate count more than 10mmol/l.
  • CBC – increased wbc
  • Blood culture positive for micro-organism
  • ESR – elevated
  • CRP – elevated
  • Procalcitonin – elevated
  • NAAT – to rule out gonorehoea
  • Ultrasound – joint effusion
  • CT scan – Region involved type and extent of damage
  • MRI – Region involved type and extent of damage

HOMOEOPATHIC MEDICINES FOR SEPTIC ARTHRITIS

Septic Arthritis is a medical emergeny case and requires immediate medical intervention, any delay in treatment can cause damage and complete destruction of joint with in hours to days.

Acute fast acting Homeopathic Medicines are selected with special affinity to joints and pathogenesis that of sudden, severe, acute inflamation with much swelling redness. Below is the list of indicated homeopathic medicines that I prefer in case of infective arthritis.

  • APIS MELIFICA
  • BELLADONA
  • LEDUM PALUSTURE
  • RHUS TOXICODENDRON
  • BRYONIA ALBA
  • PYROGENUM
  • ACONITUM NEPELLUS
  • MEDHORRINUM
  • TUBERCULINUM
  • SYPHILLINUM

DEMENTIA

Dementia is a syndrome of cognitive deficits caused due to certain underlying disease conditions.

It characterised by weak memory, decreased ability to think, calculate, judge, reason, deterioration of language, difficulty in orientation of time and location, lack of initiative, emotional and behavioural problems.

CAUSES OF DEMENTIA

Dementia in most patients is secondary to one or more underlying conditions that affects Central Nervous System like certain –

  • Hereditary or Acquired Genetic Disorders
  • Autoimmune Conditions
  • Metabolic Disorders
  • Vascular Diseases
  • Prions Disorders
  • Infectious Diseases
  • Injuries
  • Surgeries
  • Alcoholism
  • Drug addictions
  • Medications
  • etc.

Below mentioned are the most common diseases that shows symptoms of dementia.

  • Alzheimer’s Disease(60-80% of all cases)
  • Vascular Dementia(20% of all cases)
  • Fronto-Temporal Lobar Degeneration
  • Dementia with Lewy Body
  • Hutington’s Disease
  • Parkinson’s Disease

Of all the causes of dementia, Alzheimer’s Disease is present in almost 60-80% of all the cases as the underlying cause of dementia, making it the most common cause of dementia. In many patients Alzheimer’s Disease co-exists with some other condition as underlying cause of dementia.

Depending upon the underlying cause and its stage of progression it may be either

  • Non-Progressive or Slow-progressive or Fast-progressive
  • Reversible or Irreversible

Presence of number of symptoms, its appearance, sequence and intensity depends upon the underlying causative disease condition.

More or less the overall picture of dementia remains the same in various diseases only weightage to different parameter like (recall, Orientation of Time and Place, Attention and Calculation, Registration, Recall, Repetition, Language, Complex Commands) of cognitive deterioration differs a bit in different diseases and different stages. This helps in rough clinical assessment of underlying condition.

SIGNS AND SYMPTOMS

It is characterised by symptoms borne out of cognitive deficits

  • Forgetfulness especially recent events causing patient to misplace things and ask repeated questions, repeats phrases, difficulty in recalling names of objects or persons.
  • Decreased ability to think, making patient seem irrational in judging, reasoning concluding, taking decisions, initiatives
  • Lack of attention and difficulty in calculations makes it difficult for patient to maintain his finances.
  • Reduced vocubulary, causing deterioration in language.
  • Difficulty in orientation of time, directionality and location causing patient of getting lost frequently.
  • Difficulty in recognising and identifying objects due to lack of visuo-spatial articulation.
  • Tremors, difficulty in balancing.
  • Difficulty in eating especially swallowing needs liquid or thickened liquid diet.
  • Difficulty in daily routine, house keeping and self care.

All this above neurocognitive disorders results in emotional problems and low spirits and other neuro-psychiatric symptoms as mentioned below

Common Neuspychiatric symptoms of dementia are termed as “Behavioural and Psychological Symptoms of Dementia -BPSD” listed below

  • Anxiety
  • Depression
  • Agitation
  • Aggression
  • Restlessness
  • Impulsive
  • Elated
  • Sleep disorders
  • Delusions
  • Hallucinations
  • Disturbed Appetite
  • Lack of attention
  • Difficulty in problem solving

Initially symptoms are very difficult to notice and only close relative can judge or evaluate the signs and symptoms.

Over time these symptoms starts becoming more noticable as the patients condition starts deteriorating as the disease progresses.

The progression of disease is divided into four stages, where in, above mentioned symptoms gradually worsen in each progressive stage viz.

1)Mild Cognitive Impairment (MCI)

  • Scores 27-30 on MMSE scale of cognition.
  • No one can notice easily untill patient is evaluated.
  • Impairement is not so severe so as to interfere persons Activities of Daily Living (ADL).
  • At this stage patient is not termed as dementia patient its more of a prodromal phase
  • Not all but most of these patient deteriorate in cognitive deficits and progress in to Early Stage Dementia

2)Early Stage Dementia

  • Scores 20-25 on MMSE scale of cognition.
  • Only close relatives and caretaker can notice the signs and symptoms.
  • Difficulty in complex activity and comands.
  • Signs and symptoms depends much upon the underlying disease, that which symptom will be more pronounced. Eg. In dementia of Alzheimer’s Disease the memory related symptoms will be more pronounced in first stage while in dementia with lewy bodies and frontotemporal difficulty in organisation and planning will be more pronounced.

3)Mid Stage Dementia (or Moderate)

  • Score on MMSE scale 6-17.
  • Now the symptoms are noticable to everyone.
  • Gets confused in unfamiliar place.
  • Can do only simple work much difficulty in Instrumental Activities of Daily Living(IADLS).
  • Needs frequent reminders for everything
  • At these stage they have started becoming dependent and cant be left alone.

4)Late Stage Dementia (or Severe)

  • Sore on MMSE scale below 6.
  • Cannot do even Basic Activities of Daily Living(basicADLS)
  • Requires full-time assistance and become completely dependent cannot be left alone.
  • Patient cant easily recognise even close relative.
  • Tremors and loss of balance, may fall and injure themself.
  • Difficulty in identifying and handling objects in this case they might accidentally injury themself by misshandling objects.
  • Difficulty in eating espescially in swallowing, liquid or thickened liquid diet is prefered.
  • Cannot retain urine or stools and requires assistance in toilet hyegine.
  • Issues with appetite, sleep and behaviour.

DIAGNOSIS

COGNITION TESTS

There are many patient based/caretaker based/ combination of patient cum caretaker based questionaire tests designed to evaluate cognitive skills of patient.

These tests helps us to evaluate different parameters of cognitive skills like

  • Memory Recall
  • Orientation of Time
  • Orientation of Place
  • Attention
  • Calculation
  • Registration
  • Repetition
  • Language
  • Complex Commands
  • Etc

Based on the score weightage of different parameters and the total score we can not only assess the grading and stage of the condition but also it gives rough differentiation on probable underlying disease that has caused dementia. Accordingly we can determine if any further investigations are required to diagnose the underlying disease.

Every tests has its own pros and cons and specificity and sensitivity. So more than one of the following test may be called in if required.

Patient Specific Tests

  • MMSE – Mini Mental State Examination
  • 3MS – Modified Mini Mental State Examinations
  • AMTS – Abreviated Mental Test Score
  • CASI – Cognitive Abilities Assessment Instrument
  • MoCA – Montreal Cognitive Assessment
  • Trail Making Tests

Questionaires for Caretakers Relatives and other informants

  • IQCODE – Informant Questionnaire on Cognitive Decline in the Elderly

Combination of Patient specific and informant specific questionaires test

  • General Practitioner Assessment of Cognition

LABORATORY INVESTIGATIONS

  • Blood tests to rule out any other anomalies like and vitamin deficiencies, hormonal imbalances, electrlyte imbalances, infections that may potentially show similar symptoms.
  • MRI, CT, PIB-PET, DTBZ-PET, helps diagnose some of the disease that are know to cause dementia.
  • Brain Biopsy to confirm the doubted underlying disease condition.
  • CSF analysis.

HOMEOPATHIC MEDICINES FOR DEMENTIA

  • LACHESIS
  • HYOCYAMUS NIGER
  • GELSEMIUM SEMPERVIRENS
  • ANACARDIUM ORIENTALE
  • BACOPA MONNEIRI
  • OPIUM
  • CANABIS INDICA
  • BELLADONNA
  • BAPTISIA TINCTORIA
  • TERRENTULA HISPANICA